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Indiana rates for HCPCS 21395

Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$937.18 / $2,408.55 / $17,225.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.86 / $939.38 / $1,274.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.40 / $10,338.00 / $26,304.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$820.74 / $1,105.40 / $1,525.45
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$924.26 / $1,268.59 / $1,902.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.14 / $1,132.68 / $1,631.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.01 / $1,217.07 / $2,056.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.66 / $1,075.39 / $1,914.20